The surgical treatment of lipodystrophy using suction-assisted lipectomy has evolved rather dramatically over the past fifteen years. It was first introduced in Europe in the late 1970's and began to attract attention in the United States in the early 1980's. It was first practiced using sharp curettage with secondary suction and later evolved to a more controlled vacuum suctioning of fat using large blunt cannulas. Eventually smaller specialized cannulas and various suction techniques were introduced allowing more selective and controlled removal of adipose tissue. More recently, the introduction of the tumescent technique has reduced fluid and electrolyte shifts allowing larger volumes of fat to be removed.
The most recent "advance" in the field of body contouring is the introduction of ultrasonic-assisted liposuction. The application of ultrasonic energy to adipose tissue "emulsifies" the fat by cellular cavitation causing the release of fatty acids into the intercellular spaces. The combination of the free fatty acids, normal interstitial fluid and the tumescent fluid forms a stable fatty emulsion which can then be extracted from the subcutaneous space using small suction cannulas. Proponents of this technique contend that it is a safe method of body contouring and that it has a number of advantages over traditional liposuction techniques. It is reported to allow greater suction volumes per patient with significantly less blood loss, better control of contour and physical alteration of the overlying skin.
The equipment and instrumentation used for ultrasonic-assisted liposuction generally consist of an electrical signal generator, a hand-piece unit including a piezoelectric crystal to transform the electrical energy from the generator into mechanical vibration and a solid or hollow probe which amplifies the longitudinal motion and provides the direct surface area (tip) for generating cellular cavitation. Various probes have been designed in an attempt to facilitate the evacuation of aspirate during the application of ultrasonic energy. In addition, some probes allow for the infusion of fluid within, or around the probe, providing a cooling mechanism for the probe-soft tissue interface.
The surgical procedure requires a full thickness linear skin incision. The ultrasonic probe or cannula is delivered through the skin incision. The probe is continuously placed in motion by the surgeon during the application of ultrasonic energy as research has demonstrated static positioning may potentially increase the risk of thermal abrasion.